Overview

Carpal tunnel syndrome is the most common nerve entrapment problem in the body. It can occur in anyone but is more common in females over 40 years.

Causes & Symptoms

Carpal tunnel syndrome occurs when the median nerve is compressed at the wrist. The nerve passes through a tunnel at the palmar side of the wrist, and if there is increased pressure here, the nerve is compressed. In many cases, there is no specific cause but medical conditions that may cause increased pressure in this area include pregnancy, thyroid disease, rheumatoid arthritis and diabetes. It can also be brought on by repetitive motion and certain sporting activities such as cycling, tennis and throwing.

The symptoms of carpal tunnel syndrome are classically pain and “pins and needles” mainly affecting the thumb, index and middle fingers of the hand. This commonly occurs at night time or on waking in the morning. There can be loss of sensation (numbness) and when severe weakness and clumsiness due to muscle damage.

Diagnostics

Your specialist will examine your hands and arms. Diagnostic tests include provocation tests whereby your hand and wrist are gently positioned to temporarily increase pressure in the carpal tunnel. Your symptoms may be brought on within 60 seconds if the test is positive. You may also exhibit signs suggestive of carpal tunnel syndrome such as wasting of the muscles in the hand, in particular at the base of your thumb.

Nerve Conduction Studies are used to confirm the diagnosis and involves placing pads on the skin of the hand and arm, and looking if there is a slowing of nerve activity at the wrist.

Treatments

Oral painkillers and wearing a wrist splint can be successful in treating symptoms.

A small dose steroid injection (under ultrasound guidance) with local anaesthetic may also be helpful. 80% of patients benefit from this but only 20% remain asymptomatic in a year. It may be useful as a diagnostic test and for those where surgery may not be ideal in pregnancy for example.

Carpal tunnel decompression surgery is usually performed under local anaesthetic as a day case procedure. The surgery takes about 10-15 minutes and is performed through a mini-incision (3-4cm cut). Like all surgical procedures, there are some very low risks involved with this procedure which your surgeon will discuss with you.

Aftercare

You can go home on the same day as surgery. The anaesthetic should keep working for the following 6-8 hours and you will be given oral painkillers to take for the first few days. You will be given exercises to do once at home and will be advised to keep the hand raised as much as possible in the first three days to prevent swelling. Your dressings will be reduced to a simple dressing following two days.

Sutures are typically removed at 12-14 days.

Symptoms should improve within a week but may not be completely better until about 3-6 months. Gripping, leaning and heavy lifting may be uncomfortable during this healing period.

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